Boost for expanding Medicaid: Researchers find preventive care rises with broader insurance coverage

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Anthony Jerant, M.D.
Anthony Jerant, M.D.

People with health insurance are not more likely to engage in risky behaviors, but instead focus more on preventative care according to research at the UC Davis and the University of Rochester.

"These results do show that having health insurance affects the likelihood of receiving important preventive services that can potentially reduce the chance of an influenza-related hospitalization or death and prevent or detect colorectal or cervical cancer," said co-author Kevin Fiscella, M.D., professor of family medicine at the University of Rochester School of Medicine. "This is a critical message, as many states continue to debate whether to expand Medicaid."

The study found those with health insurance were more likely to get flu shots, make office visits and get preventive procedures such as colonoscopies. The results disproved the concern that expanded insurance would increase care and costs, researchers said.

"The notion that people with insurance will exhibit riskier behavior is referred to by economists as 'ex ante moral hazard' and has its roots in the early days of the property insurance industry," said Anthony Jerant, M.D., professor of family and community medicine at UC Davis and lead author of the study. "After buying fire insurance, some people wouldn't manage fire hazards on their property. But healthcare is different. Someone might not care if their insured warehouse burns down, but most people want desperately to avoid illness."

The researchers evaluated data from the Medical Expenditure Panel Survey, a national source on the costs and uses of healthcare. They studied information on 96,000 adults who participated for two years between 2000 and 2008, and had insurance for at least one year.

The group compared detrimental issues (smoking, seat belt use, weight gain), the use of preventive care (flu vaccinations, colorectal cancer screenings, mammography, pap smears, prostate testing) and expenditure metrics.

The findings are published in the November-December issue of the Journal of the American Board of Family Medicine.


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